Pilot Purgatory Math: The Cost of Non‑Conversion for Founders

Pilots are meant to de‑risk adoption. Too often they defer it. Inside hospitals, new products face an evaluative process that weighs clinical outcomes, safety, workflow, and cost. That complexity—spread across clinicians, supply chain/value analysis, finance, and IT—explains why otherwise successful pilots can stall in “committee land.” Research underscores the multidisciplinary reality and the need for strong, decision‑grade evidence to move from trial to purchase. BMJ Open

Where the time (and money) go

• Decision bandwidth. VACs convene to review evidence and vote; many include 12–24 members across clinical and administrative roles. Meetings are periodic, agendas are full, and incomplete submissions get bumped. Medical Product Outsourcing

• Budget windows. Even when clinical fit is clear, purchases often must align to operating or capital budgets; in a financially pressured environment, unbudgeted items face heightened scrutiny. American Hospital Association

• Reimbursement uncertainty. If inpatient costs outstrip payment (absent NTAP), or outpatient use lacks device pass‑through, finance will pause until a path is clear. Centers for Medicare & Medicaid Services+1

• Procurement plumbing. In many health systems, GPO alignment influences contracting speed and terms—particularly beyond a single‑site pilot. OUP Academic

The (simple) math founders should run

• Lost ARR from delays: Lost ARR ≈ Contract Value × (Months of delay ÷ 12). A $240k/yr contract that slips 6 months = $120k in lost revenue year one.

• Pipeline decay: Extended cycles lift customer acquisition cost and increase competitive risk; a second budget slip is often a full‑year deferral.

• Internal burn: Each incremental month consumes founder time and cash—without compounding reference value.

In practice, even committed health systems describe several‑month VAC timelines; some report 3–6 months or longer depending on readiness and queue. Tight, decision‑ready submissions compress that curve. Accretive Edge

How to avoid pilot purgatory

1. Define success triggers before kickoff. Clinical, operational, and economic metrics tied to decision thresholds—plus the data capture plan. Evidence‑based purchasing benefits from well‑designed user trials. BMJ Open

2. Pre‑wire value analysis. Meet the VAC lead early; align on the evidence dossier and submission format. VACs expect structured, comparative documentation of value. ScienceDirect

3. Clarify reimbursement. If NTAP/OPPS pass‑through applies, show coding and payment mechanics; if not, show how cost is offset within the service line. Centers for Medicare & Medicaid Services+1

4. Plan the budget path. Identify whether the first contract is operating or capital; specify timing and, if needed, a bridge (limited rollout, evaluation-to-purchase SOW). Hospitals’ financial headwinds make this planning mandatory. American Hospital Association

5. GPO awareness. Know whether a local carve‑out is feasible now and when national contracting becomes a gate. Most hospitals are GPO‑aligned in some way. OUP Academic

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